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Monday 20 July 2015

"A TERRIFIC SUGGESTION." - A Checklist To Stop the Potential Misuse Of Psychiatric Medication In Young Kids - by Professor Allen Frances and Dave Traxson Courtesy of the PsychologyToday website

   A perfect storm of interacting detrimental factors has resulted in the recent massive overuse of psychotropic medication in children.
   Drug companies started to focus their marketing campaigns on kids when the adult market was saturated. Children make perfect customers- get them used to psycho-active pills when they are young and they may continue to use them for life.
   Doctors have swallowed the misleading sales pitch that typical kiddie problems are really underdiagnosed and undertreated 'mental disorders'- very easy to diagnose and very easy to treat with a pill. Just the opposite is true. Children change so much in response to environment and development that their diagnosis and treatment always require the greatest care, patience, and time. I can't picture ever starting a child on meds after a brief evaluation, but this is often done.
   Parents far too readily follow doctors' advice about medication for their kids. I recommend always becoming a fully informed consumer and getting second and third opinions before allowing your child to take any psychiatric medicine. This is an important decision that requires careful deliberation and full parental input.
   Overwhelmed teachers often recommend that parents take their kids to doctors for medicine when the problem may be more in the classroom than in the kid.
   Dave Traxson, a Child and Educational Psychologist in the United Kingdom, has come up with a terrific suggestion to help contain the epidemic of careless medication in kids. He has developed a Checklist of questions doctors should think about before prescribing psycho-active drugs to kids. Dave writes:
   "There has been an unchecked, exponential growth in the use of psycho-stimulants, anti-depressants, and anti-psychotic drugs in kids- often harming more than helping them.
   I have devised a Checklist to help clinicians think through the necessary steps that should be part of every careful prescription of medication for children.
• Does the child have a classic presentation that closely conforms to an approved indication for this particular medication?
• Is there well documented research on efficacy and safety with children of the same age,gender, and social grouping?
• Are the child's problems pervasive, occurring in a wide range of social settings and observed by many different individuals?
• Are the child's problems severe, enduring, and impairing?
• Do the child’s parents and involved professionals see the problems as significant enough to require medication?
• Are there stresses in the child’s relationships, social context, and recent history which might explain this pattern of behaviours?
• Has a psychological or social intervention been tried prior to prescribing medication?
• Have there been any significant adverse side-effects from medication?
• Have you carefully weighed short and long term risks and balanced them against possible benefits?
• Have you received informed consent from the parent and (where appropriate) the child?
& perhaps the most telling question
• If your child or a member of your circle of family and friends had the same presenting problems, would you be  prescribing medicine - NOW?"
   Thanks, Dave. Inappropriate kiddie prescribing has been fueled by billion dollar drug company marketing- so far, with little pushback from doctors, mental healthprofessionals, parents, and teachers.
   We simply don't know what will be the long term impact of bathing a child's immaturebrain with powerful chemicals. We are now conducting an uncontrolled experiment without informed consent with unknown consequences for millions of our kids.
   There are childhood problems that certainly do require medication, but this should only be a last resort after careful consideration of less invasive interventions. Medication should never be, as it now too often is,  a first and careless reflex. Dave Traxson's Checklist is an excellent guide to more responsible practice.
   And parents must be mindful of the need to protect their kids from excessive medication use. There is not a pill for every child-rearing problems. Never accept a prescription if it has been written after a quick evaluation without a full exploration of alternatives. 

Bad Pharma by Ben Goldacre Review from Luisa Dillner of the Guardian October 2012

LINK FOR ARTICLE : http://www.theguardian.com/books/2012/oct/17/bad-pharma-ben-goldacre-review -

Luisa Dillner
Wednesday 17 October 2012

If you were shocked by the MPs expenses scandal, try this one: in America, a popular media doctor, Drew Pinsky, goes on air to praise the antidepressant Wellbutrin. What's so great about it? Whereas other antidepressants lower libido, this drug "may enhance" sexual arousal. What his loyal listeners don't know is that Pinsky has been paid $275,000 by GlaxoSmithKline "for services to Wellbutrin".

They might never have found out if the US Justice department hadn't taken GSK to court for illegal marketing and failing to report drug safety data. The nine-year investigation led to a $3bn fine. (Other pharmaceutical companies have been fined for similar misdemeanours.) This example doesn't make it into Ben Goldacre's Bad Pharma, his calmly outraged account of how the $600bn drug industry, doctors, academics, regulators and medical journals have let patients down. But it is by no means extraordinary.

Goldacre's previous book Bad Science is an easier read, since exposing charlatans can, at times, be played for laughs. Bad Pharma is altogether more sombre and grim – a thorough piece of investigative medical journalism. What keeps you turning its pages is the accessibility of Goldacre's writing (only slightly flabby in places), his genuine, indignant passion, his careful gathering of evidence and his use of stories, some of them personal, which bring the book to life.

His tales of drug companies buying the opinion of doctors is not the most alarming of his revelations. Goldacre sets out clearly what is wrong with the way drugs get on to the market. New drugs are tested by the companies that make them, often in trials designed to make the drug look good, which are then written up and published in medical journals. Unless, that is, the company doesn't like the result of the trial (maybe it shows the drug not working or having severe side-effects), in which case this result might be hidden. Regulators should have all the data on a drug's effects but they often don't share it, so researchers can't study the data. The book gives examples of regulatory bodies handing over page after page containing blacked-out results to academics trying to collect data from unpublished trials, the excuse for non-disclosure being commercial sensitivity. Companies pay doctors to extol the virtues of their drugs on the conference circuit (spelling out the sources of information they want doctors to use) and fund patient groups to lobby regulators to approve new drugs. Academic journals (I work for one, the BMJ) are sent research papers and comment pieces that may not always be written by the academics listed as the authors. If a journal does decide to publish a paper showing the benefits of a drug, it can be rewarded by the company which made it, who might buy up hundreds of thousands worth of reprints (glossy versions of the published paper) to distribute to doctors to encourage them to prescribe the drug.

Doctors generally want to do the best for their patients, but they can't know what that is if half of the data on clinical trials of drugs is missing and some of the rest is distorted. The editors of medical journals want to publish good research but know, as Goldacre says, that when companies test their shiny new drug against other treatments, they don't always play fair. The vital comparison may be made against a placebo (Goldacre gives a harrowing account of how such a trial led to children in India dying when there was a perfectly good drug to treat them) or against unusually low or abnormally high doses of the drug – to ensure suitable conclusions as to efficacy and the severity of side-effects. It's no surprise that most published trials funded by drug companies show positive results.

Poor trials you can at least analyse. Missing data, Goldacre says, poisons the knowledge-well for everyone. Consider rosiglitazone, a new type of diabetes drug, which was greeted with real enthusiasm in 2005-6. This was partly because, unlike most new pharmaceuticals, it wasn't a "me too" drug. (With "me too" drugs companies tinker with a product they already sell but that is coming out of patent – it's a cheaper way of making a "new drug" although its additional benefits may be minimal.) Rosiglitazone was lauded for reducing blood sugar levels in people with diabetes and so for reducing heart attacks. Before long, however, John Buse, a doctor from the University of North Carolina became concerned that instead of reducing heart problems, the drug was actually increasing them. His head of department was rung by GlaxoSmithKline, the company who made the drug; a US Senate Committee later released a report saying Buse had been subject to intimidation. Later, GSK added up results from many trials and found Buse was right. They released their results, but only after two years. Independently Steve Nissen, a cardiologist, did his own analysis and found a 43% increase in the risk of heart problems with rosiglitazone. In 2010 the drug was taken off the market.

What will be the response to Goldacre's book? Drug companies may say that the problems he identifies have now disappeared. New rules insist they register the details of trials, and publish the results – whether negative or positive. But as Goldacre points out, little has really changed, because no one checks up.

Poor research and bias cannot be placed simply at the door of drug companies. The BMJ revealed earlier this year that half of publicly funded research in America wasn't published within the required time period. Doctors are often resistant to the notion they could ever be influenced by ads and sponsorship, even though the evidence to the contrary is overwhelming. They also rely on education paid for by drug companies because (unusually among professionals) they are loath to pay for it themselves. At the BMJ we are revising our declarations of interest form to say we will seek to work with doctors who have not received financial hand-outs from drug companies (funding for research is different).

But pharmaceutical companies are, after all, not charities. They exist to make and sell drugs, some of which work well, and to make a profit for their shareholders. They may talk as if they want to improve healthcare and sometimes they mean it, but only proper regulation from external agencies will make any difference. There is evidence that companies spend much more on marketing than they do on research and development (in America 24.4% of the sales dollar is spent on promotion versus 13.4% on research and development). They also inflate the cost of developing new drugs – Goldacre cites companies claiming that it costs £550m to bring a new drug to the market but says others put it at a quarter of that cost.

Some of what Goldacre wants to see is indeed happening – in America the so called Sunshine Act will mean pharmaceutical companies must say how much they have paid doctors and for which activities. And websites such as ProPublica already enable any patient to see what his or her doctor has been paid by the industry. One of Goldacre's innumerable discoveries is that in 2010 a Dr Emert in West Hollywood ate $3,065 of food paid for by Pfizer. Since this book's publication GSK has already announced it will make all its trial data available. Perhaps Goldacre's medicine is already working.

Building Relationships with Troubled Children: Insights from Torey Hayden - Courtesy of the Goodenoughcaring.com website

Building Relationships with Troubled Children: Insights from Torey Hayden
By Michael J. Marlowe
Professor Michael Marlowe teaches at the Appalachian State University in Boone, North Carolina, United States of America

Building Relationships with Troubled Children: Insights from Torey Hayden
Torey Hayden, a teacher of children with emotional and behavioural difficulties, has authored eight books chronicling her day to day work in special education and child psychology. Hayden’s first book was One Child (1980), the story of Sheila, a silent troubled girl, who had tied a three year old boy to a tree and critically burned him. One Child was followed by Somebody Else’s Kids (1982), Murphy’s Boy (1983), Just Another Kid (1986), Ghost Girl (1992), The Tiger’s Child (1995), the sequel to One Child, Beautiful Child (2002), and Twilight Children (2006).
Hayden’s teacher stories are remarkable for their emphasis on relationships (Marlowe 2006, 2011). They stress the interpersonal dynamics and emotional connections involved in working with hard to reach children. Her stories give special voice to the power of relationship skills, intuition, and the social milieu in changing behaviour, and they emphasize the synergistic power of relationships between a teacher and her students. In her prologue to The Tiger’s Child, Hayden noted this reciprocal effect in her relationship with Sheila: “This little girl had a profound effect on me. Her courage, her resilience, and her inadvertent ability to express that great gaping need to be loved that we all feel – in short, her humanness brought me into contact with my own.” (Hayden, 1995, p. 8)
While Hayden is open about the fact that she follows no specific model, I have distilled from her stories an approach to educating children with emotional and behavioural difficulties which could be termed the relationship-driven classroom (Marlowe and Hayden, 2013). The cornerstone of this relationship-driven approach is commitment. It is the unequivocal commitment of one individual to another, of Hayden to the child she is working with, that evokes positive change. Troubled children have to have this type of relationship if they are going to move forward. They need the esteem that comes only from knowing others care about you, others value you sufficiently to commit to you. They need to know that while significant others may have been unable to provide this type of commitment, it does not mean they are unworthy of it. As Urie Bronfenbrenner (2005) proclaimed, every child needs at least one special adult who is irrationally crazy about him or her, for only then can the child develop to full potential.
Relationship Skills
Whether you are a teacher, a child and youth care provider, or a foster parent,
there are certain skills and concepts that underpin relationships as a means of change. Four skills are fundamental to the success of using relationships with troubled children or youth. Of all available social skills, these are the ones that are most crucial in order to create the strong and healthy bonds necessary for effectively using relationships as a medium of change (Marlowe and Hayden, 2013).
The key quality of self-awareness is the ability to step back from one’s emotions and cognitive activity sufficiently to be able to discern what one is feeling and thinking. The other key quality is to have a reasonable understanding of why one does the things one does and how one’s feelings and thoughts influence one’s actions. Those skilled in self-awareness are able to maintain this awareness as they are thinking and feeling and to make use of the small space between antecedent action and their behavior to actively choose how they will respond.
This crucial skill ensures that we can maintain our own behaviour as a conscious action and respond rather than react to what the child is doing. This allows us to monitor and make the almost continuous small adjustments to our own behaviour necessary to discourage inappropriate behaviour and encourage appropriate.
It is the fundamental skill upon which all other skills and, ultimately, all personal change are based. Self-awareness must always be present. Without awareness of what we are doing, it is impossible to make any kind of significant or lasting change.
Objectivity refers to the ability to let go of the self-oriented point of view and see things from either the perspective of another person or from a general perspective external to ourselves. In cultivating objectivity, we recognize three things: a) that our own perspective is limited; b) that the other person also has a limited perspective which will be unique to them and different to ours because they have had different life experiences and circumstances; and c) that there is always a “bigger picture” which is both outside these individual subjective perspectives and inclusive of them.
When self-awareness and objectivity work in tandem, they allow us to see our own perspective is our own, to step back from it sufficiently to discern others have different points of view that will feel as internally valid to them as ours does to us, and to be able to step outside both to view the “bigger picture.”
There is a duality present within the relationship-driven approach. On one level it is all about self-awareness and objectivity, which means recognizing that what we think, feel and experience affects our actions, but that we each think, feel, and experience differently. On another level, however, it is about recognizing that we are all, in fact, alike. Our differences are superficial. At our core, we ALL much more alike than different.
While we each have our own subjective realities and we need to be aware of this, we must also remember that we all share the same basic humanity, no matter how different we may appear from the outside. We all experience fear, joy, pleasure, anger, discouragement. We all experience pain, tiredness, arousal, hunger, illness.
An understanding of this commonality allows tolerance and acceptance to develop because it enables us to let go of fear about the other person’s differences. We are hard wired to be afraid of things we do not understand. The ablity to perceive common traits allows us to understand the other person, however, different, bad, repugnant, et cetera, is at the heart really just like us, and so we don’t need to fear them. . It helps us realize that however bizarre, incomprehensible or misguided their actions, they are acting in an effort to feel better or avoid pain, just like we do. This helps us accept the child is not a “beast” or “inhuman” or “unreachable” and that within him or her there will be feelings, sensations, perceptions and experiences like our own and if we can connect with this common ground we have a chance of bringing about change.
It isn’t necessary to be an extrovert to make relationships work as a methodology, but it is necessary be sincerely interested in other people and to find a natural enjoyment in interacting with them. External methodologies where focus is solely on the maladjusted behaviour and controlling it are not dependent on personality characteristics of the teacher, residential counsellor, or foster parent. In order for relationships to work as a means of behavioural change, however, the adult needs a certain level of natural friendliness in order to be at ease forming relationships.
These four skills are fundamental to relationships in general. As well as these necessary skills, there are seven philosophical principles which underpin and inform all action taken in a relationship-driven milieu (Marlowe and Hayden, 2013).
Relationships are a process, not a goal
There are two different approaches whether it is working with troubled children or whether it is towards life in general – goal orientated or process orientated Both orientations are a normal part of human behaviour. In goal orientation you do what you do for the ultimate outcome. With a troubled child, for example, you work with him because you have expectations of making him better and more capable of living a fulfilling life. You have expectations of an outcome from the time you undertake what you are doing. Fulfillment comes when you reach the goal.
In process orientation you do what you do for the process of doing it. With a troubled child you don’t have any expectations of what’s going to happen because you are not looking at the future. You work with the child because you enjoy the act of being with the child. This means you focus on the process, the doing of something, rather than the outcome. Consequences or outcome of the experience may reinforce the behaviour but they are not at the heart of this orientation. Fulfilment comes instead from awareness and appreciation of having the experience while it is happening.
Relationships are, by their very nature, process oriented. They are ongoing and now. The relationship-driven model is present oriented because relationships only exist in the present. Thus in order to use relationships as a way of changing behaviour, one must be oriented to the present process as opposed to towards a future goal. In other words, the relationship the adult has with the child now is used to change behaviour as opposed to its being a reward or an outcome of the change. The adult is working with the environment, modifying what is happening “right now” by means of relationship skills, intuition and social milieu, all of which exist only in the present.
Hayden works with children because she thoroughly enjoys the process itself. She loves the act of being with the children. While she is open to the fact that improvement for her children is desirable, this is not what guides her work. Her pay-off, her fulfilment in working with children comes during the time spent together, during the interactions, during the moment itself.
There is a difference between the person and the person’s actions
In order to relate in a warm and tolerant manner, we must accept that each person is ultimately separate from his/her actions and thus has the potential to control and change his/her behaviour. It is crucial to understand this distinction between what we do and who we are. We cannot change who we are. We can change what we do. Actions belong to us and in that way they are part of us and we are responsible for them, but they are only one part of a greater whole. They are not the whole itself. This is one of the most basic tenants of the relationship-driven approach. It is the concept that powers the confidence that change can take place, no matter how appalling the current circumstances. Self-esteem can be rebuilt; motivation can be re-instilled; new lives can take form as long as there is the hope that this is possible. And this hope resides in the understanding that what we do is not who we are.
No one chooses to be unhappy
Hayden believes we all want to be happy. Everything we do, no matter how odd or misguided, is done because we think consciously or unconsciously that it will lead to our feeling happier. This is simply another way of saying “Everyone is doing the best they can.” Children engaging in difficult or destructive behaviour do so in erroneous belief that this will relieve their unhappiness. They are not actively trying to be unhappy. Instead, they are actively trying to be happy but going about it in an unproductive way, because – for whatever reason – they are simply not able to do differently at this point in time. A misbehaving child isn’t wilfully choosing to be unhappy. He/she genuinely hasn’t come up with a more effective way of being happy.
Misbehaviour is a teaching opportunity
If everyone wants happiness and no one wants unhappiness, yet there is misbehaviour that results in unhappiness, then we can assume the person does not know how to do differently. If he/she did, he/she would be doing it, because unhappiness makes one feel dismal. If, on the other hand, someone doesn’t know how to do differently, then the appropriate response from those who do is to teach him or her how.
A gigantic amount of misbehaviour occurs because the child simply does not know how to behave differently, because he has misconceptions about how he should behave, or because he has misconceptions about himself. These situations are not corrective occasions. They are teaching opportunities.
In a relationship-driven methodology, functional behaviour is taught actively via the adult-child relationship in order to give children experience of the appropriate behaviours they are expected to use. Some aspects of appropriate behaviour are taught by the adult through active modelling and others are taught to the child directly, such as how a functional person manages his/her emotions, how a functional person relates appropriately to others, and how a functional person handles negative situations. So discipline in a relationship-driven milieu can be summed up as: never pass up an opportunity to teach.
Everyone can change
Hayden believes that everyone regardless of who they are and what they have done, can change. This belief is the foundation upon which all the rest of the relationship-driven model is built.
Everybody can change is just a practical attitude. Pollyanna says, “Everyone will change.” This statement is just as black-and-white as “He’ll never change.” What Hayden wants to cultivate is the ability to stay positive about the possibility of change, and the recognition that we are not omniscient. It’s easy to fall into using black-and-white terms like “always” or “never” in regards to difficult behaviour, but in doing so we are implying that the children and situations we are dealing with are fixed, and discreet, and therefore entirely predictable, when they are, in fact, constantly changing and connected to and affected by an infinite number of other things that we have no knowledge of, insight into, or control over.
Because we may not be able to see how change will take place doesn’t mean there is no chance for change. We need to promote personal change as doable, and in the process, distinguish in our own minds the difference between “I can’t do any more to help this child” and “No one can help this child.”
Personal change is very difficult
In Hayden’s experience changing ingrained personal behaviour is very hard to do. There are many reasons for this: genetic make-up, environmental circumstances, motivation, and consequences all factor in. As a result, it is normal for the individual who is trying to change to make many approximations before managing the right behaviour. It is also normal to slip up or fail many times before eventually achieving the behaviour. It is normal for the increments of change to be very, very small and the more entrenched the behaviour, the smaller they usually have to be for success to be maintained. Because of this, it is necessary and, indeed, crucial to reward approximations of the desired behaviour as one goes along. It is also important for both adult and child to be aware from the onset that it is entirely normal to have to make such small steps and that the person making the change should be encouraged to be positive about any movement in the right direction, however minute the increments.
Change can be slow, subtle and difficult and very often happens in a manner much different to what we had planned or envisioned, so it is important children be aware of this and be aware that this is normal. We want to help children shift away from the goal-oriented judgmental perspective that “I tried. I failed. I can’t do it. I give up” to the process-oriented “I tried. It didn’t happen this time. I’ll try again.”
The world is complex
Black-and-white thinking – the tendency to perceive things as all-or-nothing and thus able to be put into discernible, discreet and permanent categories – seems to be a hard-wired trait for humans. We categorize and generalize by nature.
From the perspective of a relationship-driven approach, two of the most important reasons for avoiding black-and-white thinking are: 1) almost all behaviours are on a spectrum and not at the two (black or white) extremes. For example, we are virtually never entirely happy or entirely sad. Happy is one end of the spectrum, sad is at the opposite end and we normally tend to fall somewhere in between. Recognizing the spectrum nature of behaviour makes it much easier to accept approximations of appropriate behaviour and to see positive movement towards the wanted behaviour because we can see what is being done is further up the spectrum than the previous behaviour. In contrast, black-and-white thinking allows us only two outcomes: success or failure. And 2) black-and-white thinking tends to ignore time and the fact that all things change over time. We are not at all static creatures. We are never really the same twice. Recognizing this continual process of change allows us to recognize the potential for things to be different than they are right now. In contrast, black-and-white thinking assumes permanence and looks for opportunities to reinforce that. The black-and-white thinker looks only for evidence that reinforces categorization and ignores evidence of change. Once a bully, always a bully, for example.
So it is important when working with a relationship-based methodology that one have a clear understanding that the world is complex, that we can’t reduce it to clear-cut, comprehensible certainties. This kind of open-ended acceptance is one of the most crucial attributes for success in the dynamic realm of relationships.
Final Thoughts on Relationship-Driven Practice
Hayden has developed a philosophy of attachment and loss in forming relationships which threads through her books. For her forming relationships is central to teaching, but it inevitably implies eventual loss, just the way birth inevitably contains within it the guarantee of eventual death. One of her favorite quotes is: “A ship in the harbor is safe, but that’s not what ships were built for.” In other words, the only certain way to stay safe from loss is never having attachment, but research in psychology and sociobiology shows that we are a social species and are primed biologically to have relationships from birth (Szalavitz & Perry, 2010). That Hayden formed attachments which she knew ultimately would end simply meant she was able to keep an objective eye on what was going on in her teacher-student relationships – I’m a teacher; my ending comes in June – not that she was any better at loss than her students or that it hurt her any less. Part of what she teaches in forming an attachment, is how to cope with loss, and loss comes to all of us.
Hayden’s goal in forming relationships with her children as stated various times through her books is to help more than she hurts. She states that’s all any of us can aim for, as the perfect person or perfect relationship does not exist. She remains committed to the idea that we all do need to know in a very real way that we matter to someone, someplace, even if we cannot be together. And real love, for whatever time it lasts, is never wasted.

Bronfenbrenner, U. (2005). Making human beings human: Bioecological perspectives
on human development. Thousand Oaks, CA: Sage Publications.
Hayden, T.L. (1980). One child. New York: Avon Press.
Hayden, T.L. (1982). Somebody else’s kids. New York: Avon Press.
Hayden, T.L. (1983). Murphy’s boy. New York: Avon Press.
Hayden, T.L. (1986). Just another kid. New York: Avon Press.
Hayden, T.L. (1992). Ghost girl. New York: Avon Press.
Hayden, T.L. (1995). The tiger’s child. New York: Avon Press.
Hayden, T.L. (2002). Beautiful child. New York: Avon Press.
Hayden, T.L. (2006). Twilight children. New York: Avon Press.
Marlowe, M. (2011). The relationship-driven classroom: The stories of Torey
Hayden. Reclaiming Children and Youth, 20(1), 24-29.
Marlowe, M.J., & Hayden, T. (2013). Teaching children who are hard to reach:
Relationship-driven classroom practice. Thousand Oaks, CA: Corwin.
Szalavitz, M., & Perry, B. (2010). Born for love: Why empathy is essential—and
endangered. New York, NY: HarperCollins.

Thursday 16 July 2015

WASHINGTON POST - Most antipsychotics are prescribed to teens without mental health conditions - By Robert Gebelhoff July 6, 2015


A new study indicates that antipsychotic drug use has been on the rise among adolescents, even though most had not been diagnosed with a mental disorder.
The study, published this week in JAMA Psychiatry, used data from thousands of prescriptions to analyze trends between 2006 and 2010. The percentage of teens using the medication ticked up during the time period, with the highest rates of usage recorded among teens ages 13-18, according to the data. About 1.19 percent of that age group were using the drugs in 2010, compared with about 1.1 percent in 2006.
At the same time, 60 percent of those ages 1-6, 56.7 percent of those ages 7-12, 62 percent of those ages 13-18, and 67.1 percent of young adults, ages 19-24, taking these drugs had no outpatient or inpatient claim indicating a mental disorder diagnosis, the study said.
"There's a general consensus that great caution should be exercised with antipsychotic drugs," said Mark Olfson, lead author of the study and a professor at the Columbia University Medical Center. "This raises concerns about whether the right caution is taken."
Children ages 1-12 have seen a slight dip in antipsychotic drug usage since 2008, which the authors of the study suggest is the result of increased safety concerns. Still, a majority of this age group has also been taking the drugs without a diagnosed mental disorder.
Researchers also expressed concern that in cases where there are diagnosed mental disorders, the antipsychotic drugs are being used to treat unapproved conditions, such as attention deficit hyperactivity disorder and depression.
For children and adolescents, antipsychotics have been approved by the Food and Drug Administration to treat conditions, such as bipolar mania, schizophrenia and irritability associated with autism. They are not approved for ADHD or depression, although doctors are known to prescribe them in those cases.
Olfson said this is often done because the drugs provide a "fast relief" for behaviors in children that are difficult to manage. Parents and doctors in a difficult spot are usually willing to use drugs that are outside their approved uses.
The data does not show which disorders the antipsychotic drugs are specifically being used to treat, but more than half of young patients with mental health diagnoses taking the medication had either ADHD or depression. Less than a quarter of teens taking the drugs, on the other hand, were diagnosed with bipolar disorder or schizophrenia.
At the same time, less than a quarter of the patients undergo any form of therapy.
"We need to do more to increase access to non-pharmacological options," Olfson said.
Over the past few decades, antipsychotic drug use has surged in the United States, reaching sales of around $18.2 billion in 2011, according to the marketresearch firm IMS Health. In 2010, 2.8 million prescriptions were filled to treat teens alone, but recent studies have shown that the drugs — especially when combined with other psychotropic medications — pose health risks for young people. Studies show children taking antipsychotics are at higher risk of weight gain and increased cholesterol.
More than 80 percent of all teens taking antipsychotics are also taking other medications, such as stimulants, antidepressants and mood stabilizers, according to the study, and more than two-thirds of kids ages 1-6 taking antipsychotics are also using other psychotropic medication.
The study also said that males ages 13-18 have a much higher rate – about 1.5 times -- of antipsychotic drug use than females ages 13-18. That gap is even more pronounced in younger age groups, according to the study. That's likely because the drugs are often used to treat impulsive and aggressive behaviors, which is more common in young men. Still, the increase in use of the drugs has occurred among both males and females.
Read More:

Robert Gebelhoff covers health and science news for The Washington Post.

Tuesday 14 July 2015

GOVERNMENT ACTION - pledge on over-medication of people with learning disabilities

Urgent action pledged on over-medication of people with learning disabilities

14 July 2015 - 12:45
NHS England has today promised rapid and sustained action to tackle the over-prescribing of psychotropic drugs to people with learning disabilities after three separate reports highlighted the need for change.
Research commissioned by the health body and delivered in three reports from the Care Quality Commission, Public Health England and NHS Improving Quality has found that:
·         There is a much higher rate of prescribing of medicines associated with mental illness amongst people with learning disabilities than the general population, often more than one medicine in the same class, and in the majority of cases with no clear justification;
·         Medicines are often used for long periods without adequate review, and;
·         There is poor communication with parents and carers, and between different healthcare providers.
One of the reports, authored by Public Health England, estimates that up to 35,000 adults with a learning disability are being prescribed an antipsychotic, an antidepressant or both without appropriate clinical justification.
In a letter (also available in easy read) to professionals and patients, NHS England officials have urged the review of prescriptions, and promised to spearhead a “call to action” to tackle these problems, similar to that which has been so effective in reducing the inappropriate use of antipsychotics with dementia patients.
This will involve bringing together representatives of both professional and patient groups for an urgent summit on 17 July, at which an action plan and a delivery board will be established to drive the necessary changes.
NHS England are also considering issuing a patient safety alert to ensure that frontline clinicians and other health professionals are aware of the concerns, and have published information on their website for concerned patients and family members.
Dominic Slowie, NHS England’s National Clinical Director for Learning Disabilities, said: “This is a historic problem, but one that nobody knew the true scale of; that’s why we worked with patients, carers and professionals to get to the bottom of the issues once and for all.
“These medicines can be helpful when used appropriately and kept under review, but the prevalence and the lack of review or challenge that these reports have highlighted is completely unacceptable, and we are determined to take action to protect this group of patients from over-medication.”
While no specific research has been undertaken on the physical health implications of long-term use of such drugs on people with learning disabilities, past studies looking at patients with schizophrenia and dementia highlighted significantly increased risk of movement disorders, anticholinergic effects, stroke and death.
Individuals and their loved ones who are concerned with a current prescription are encouraged not to stop taking medication immediately, but to consult their doctor or supervising clinician as soon as possible.
Gyles Glover, Consultant in public health and Co-Director of the Learning Disabilities team in Public Health England said: “Psychiatric drugs are often given to people with learning disabilities to try and manage challenging behaviour. These drugs have important side effects, but the evidence that they are effective is limited.
“Services are overstretched and care is demanding, so we understand how the use of these drugs can be considered normal or necessary.  However the report, which is the first of its kind, suggests that psychiatric drugs are used more widely than is appropriate and this comes with risk. It is crucial that we build our evidence of what drugs are being used to manage behaviour and how often to support and guide a change in practice.” 
Zoe Lord, Improvement Manager at NHS Improving Quality, said: “We have highlighted a significant need to improve the use of medicines for people with learning disabilities.  Across the country, there is a great deal of variation in practice, and this does not provide the necessary high-quality, optimised, care for everyone.  We have tested new ways of working with our partnership sites, and propose six recommendations to improve care for service users and their families.”
Information for patients and their families and carers who believe they may be affected is now available (also in easy read).
In summary, the advice to patients is as follows:
·         Don’t stop taking medicines or change them without professional medical advice first; doing so could be dangerous.
·         Speak to the person responsible for prescribing these medicines as soon as possible, and ask for them to be reviewed.  This will usually be your GP, specialist doctor, pharmacist or nurse prescriber.
·         Please remember:
o    not all medicines that are prescribed to treat people with learning disabilities are antipsychotic or sedative medicines  – if you have any concerns, please check and speak to the person responsible for prescribing them (GP, specialist doctor, pharmacist or nurse prescriber).
o    antipsychotic and sedative drugs can be effective in treating some people with learning disabilities when used appropriately.


A report of the primary care subscribing study has been published by Public Health England on the Learning Disabilities Team website.
NHS Improving Quality has published a full report on the pilot improvement project which examined medicines practices and related matters in six sites across England which provide care for those with learning disabilities.